Brachial Plexus Injury in Sports Medicine Workup

Updated: Oct 31, 2022
  • Author: Thomas H Trojian, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Workup

Imaging Studies

Ancillary tests are often limited to radiographic studies.

  • Radiography can be used to rule out bony involvement against peripheral nerves. This is common in patients with severe neck pain, limited ROM, weakness, or chronic pain. Complete cervical spine radiographs often include the following multiple views: anteroposterior (AP), lateral, odontoid view, bilateral, and obliques.

  • Initial radiographs may reveal clues to spinal canal stenosis as a cause of the symptoms experienced. MRI of the spine may likely elucidate any evidence of canal stenosis.

Magnetic resonance imaging (MRI) is used to determine any involvement of the cervical spine or nerve roots as the cause of the brachial plexus injury. MRIs should be reserved for athletes with recurrent stingers or symptoms that last more than a week. Clinical judgment is needed as some cases warrant MRI if symptoms persist for more than 24 hours.

A systematic review and meta-analysis by Wade et al demonstrated that the mean sensitivity of MRI for detecting root avulsion was 93%, and the mean specificity was 72%. MRI offers modest diagnostic accuracy for traumatic brachial plexus root avulsion and is the only imaging study that can be used to visualize the postganglionic brachial plexus. [14]

In a study by Elsakka et al, MRI myelography that utilized three-dimensional T2-turbo spin echo with 90 degree flipback pulse ("DRIVE") was highly accurate in the assessment of preganglionic traumatic brachial plexus injuries. [15]

Ultrasound can provide only partial information because of the clavicle, and difficulty to see the outlet tract at the spine. [16] In brachial plexus cases, US may be useful but it cannot replace magnetic resonance imaging (MRI) which can be crucial for assessing the root avulsions that frequently occur in brachial plexus injury. [16] Though, Zhu et al showed that the nerve root can be seen with high resolution ultrasound. [17] Its portable and economic nature makes ultrasound a reasonable first choice in the evaluation. [18]

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Laboratory Studies and Other Tests

Laboratory studies

Laboratory studies generally are not indicated for the diagnosis of brachial plexus injuries.

Other tests

The electromyographic (EMG) studies are rarely necessary in the evaluation of stingers. The delay in development of abnormal activity limits their use to patients who have symptoms that last at least 2 weeks. EMG testing can help the physician confirm diagnosis and localize any possible lesions.

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